A study was published in Lancet Psychiatry yesterday that added to the evidence that exercise is good for one’s mental health. In this study, participants rated their mood nearly 1.5 days per month less if they exercised compared to similar people who didn’t exercise. Those who engaged in team sports, cycling and other exercise with durations of 45 min and frequencies of three to five times per week reported the best effects.

None of this is really new, but the study supports previous studies that show clear and definitive mental health benefits of regular exercise.

In a blog post from a few years ago about the dose-effect of exercise, I passed along the findings that nearly an hour of rigorous exercise, at least three times per week, can be as effective as antidepressant medication.

A newly published study notes that resistance exercise (such as lifting weights) can be useful in reducing depressive symptoms regardless of the intensity, duration or frequency of the workouts. So, go out and pump some iron to strengthen your resistance from depression! Even short, infrequent or not very rigorous workouts are helpful.

An interesting study was recently presented at the ApA conference: there is now limited testing available to determine which SSRI or SNRI antidepressant medication is more likely to work for you based upon your genetics. The study was funded by the testing company, but is worth looking into for more information. Hopefully this will prevent the “hit or miss” experimental approach of selecting antidepressants based upon side-effect profiles, and waiting 2-6 weeks to find out if the clinical guess was a good one or not. The article is on Medscape (you might need to register for a free account to access it).

The CDC’s National Center for Health Statistics just put out a report about the increasing use of antidepressants. As a psychologist (as opposed to a psychiatrist), I have mixed feelings about this. On the one hand, there have been many studies that have demonstrated the superior or at least matched efficacy of psychotherapy over medication to treat depression and anxiety, so I find this trend concerning. But on the other hand, when I recommend that some of my patients should consider consulting with their primary care provider or a psychiatrist and they express concerns about stigma, weakness or other reasons not to consider this treatment option, I attempt to reassure them that “antidepressants are one of the three most commonly used therapeutic drug classes in the United States” according to the report, and thus they should not feel self-conscious about taking such medications.

The report noted that there has been a progressive increase in antidepressant use since 1999, and that during the time of the study, nearly 13% of people over the age of 12 in the US have reported taking antidepressants in the past month. Women take antidepressants at double the rate of men. A quarter of those who reported using antidepressants have taken them for at least ten years.

It’s reassuring that those who need to take medication are in good company, but it is important to explore non-medical treatment of depression and anxiety, as the beneficial effects tend to be of a much longer-lasting duration.

A recently published meta-analysis of over 3000 studies suggested that switching antidepressants after the first drug doesn’t produce the desired results is not better than staying the course and/or exploring options other than trying a different drug. This is a very interesting finding as most prescribing clinicians tend to give one antidepressant a “trial” of about 6-12 weeks. If things aren’t better then often scrap that medication and start another 6-12 week trial of another one. The authors of this article reviewed 3234 relevant studies and concluded that it is generally wiser to explore alternatives other than a medication change.

A recent research letter, published by JAMA, reported that one out of six American adults take at least one psychiatric medication. As a clinical psychologist I understand the benefits of non-medical treatments for psychiatric illness, but that doesn’t mean I don’t appreciate appropriate use of psychiatric meds. In fact, I refer a significant number of my patients to their primary care providers or to psychiatrists for medications, and I often make suggestions to the prescribing professionals about which medication I believe would work best for the referred patient. Nearly every time I do this, however, I have a long discussion with my patient about what it means to be on a psychiatric medication, and what it doesn’t mean. I almost always say something like, “several of your friends and several of your coworkers are on [psychiatric] meds… but they just haven’t told you,” in an effort to communicate how prevalent they are. This letter drives that point home really nicely.

But what I really like about the letter is that it also talks about how some medications are not be prescribed appropriately. Two classes of drugs that are most frequently mis-prescribed are benzodiazapines (e.g., Ativan, Xanax) and sedative/hypnotics (e.g., Ambien), which are supposed to be used short-term, not for months or years at a time.

I was recently interviewed for a Medscape article about maintaining professional boundaries, entitled, When Patients Try to Seduce Doctors. It’s a relatively short piece and, though I was misquoted a little, it has some good information about the doctor-patient relationship and the importance of establishing and upholding appropriate professional boundaries. Check it out.

A recent article in The Wall Street Journal summarizes some of the explanations about how we think placebos work. If you read an earlier blog post I wrote about placebos, what I find so fascinating about all this is that even when subjects/patients are told they are receiving a placebo (either in the form of a sub-therapeutic dosage of a real medication or just a sugar pill), they often still show the suggested effects of that “treatment.” If people expect something to happen when they take a pill, it often does. For example, this self-confirming bias occurs with medication side effects: you read that horrible insert from the pharmacist that lists every possible side effect that has been reported for the drug and sure enough you start to experience some of the effects… right away, before it’s really physiologically possible for the medication to have caused them.

Though some of my colleagues may not like this, I’d imagine that a nice chunk of what happens in psychotherapy is related to the placebo effect. We might call it a safe holding environment, positive future orientation or something like that, but the fact of the matter is that when a patient comes into therapy expecting a positive outcome, they typically experience that. (Similarly, when patients initiate treatment with negative expectations, they often don’t get much from treatment.) Clearly, a difference between psychotherapy and placebo is that actual treatment is being provided with psychotherapy, but patient expectation, therapist suggestions and patient suggestibility all play a significant role in therapy and should not be underestimated.

Let’s face it, all couples argue (well, some don’t but they probably don’t communicate much). Typically when we argue we we try to convince the other person that we are right and they are wrong. In doing so we tend not to listen much; instead while the other person is speaking we are thinking up a good come back or a verbal zinger to put the other person in his or her place. Pause for a moment and think about how effective this really has been for you.

Sometimes, along the way, couples escalate and start calling each other names or slinging insults (or even physical objects) at each other. Again, how well does this work? Now maybe you win some battles but you (both) lose in the end. After all, if you care about your partner, and you “win” that means he or she “loses.” Furthermore, when you sling mud during an argument, that needs to be cleaned up afterward.

Could there be a better way? Sure! What people really want when arguing is usually to feel listened to and understood. Sure, we might want our partner to agree with us and do things the way we want, but most of the time if you truly feel understood by your partner, the heat of the argument fizzles quickly and there’s nothing to apologize about afterward.

So how do you do this? As with most skills, it’s a good idea to do skill-building exercises and to practice these exercises. The exercise I’m about to describe is not how people actually talk to each other on a day-to-day basis; it’s an exercise. It’s kind of like a runner who wants to improve her time will do interval training: instead of just going out for a run as she usually does, she’ll sprint from one utility pole to the next one, then rest/jog to the next utility pole, and then run to the next one. If she repeats these “intervals” her running times improve. That said, you’ll never see someone run a marathon alternating between sprinting and walking from utility pole to utility pole.

Oh, another thing about the exercise: it’s frustratingly slow. You’ll likely hate this at first, but the slowness is part of it’s benefit. If you have to argue really slowly, you’re less likely to escalate to yelling.

So here’s the recipe:

Start

Person A: Speak to Person B for up to 30-45 seconds making a simple statement, request, argument, etc.

Person B: Either give a thumbs up to acknowledge sufficient accuracy of the paraphrased response or thumbs down so you can offer clarification.

Repeat

Remember, this is not as easy as it seems, and to become a better arguer you’ll need to become a better listener. The more you listen (and communicate to your partner that you understand him or her), the less you’ll need to argue.

Give it a shot, and like any new exercise routine, don’t give up after one or two tries; instead, commit to practicing this (about real issues, not current events or the weather) for about 10 minutes every day for at least a week straight.

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I bring decades of experience working in a variety of settings and with a variety of people to my clinical practice. In addition to doing therapy with couples and individuals, I specialize in helping people like you deal with work-related problems.